Agenda - 05-07-2013 - 4b; VAD - Green, Ward, Pope, Walters

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16 rj&L Orange County Agricultural Preservation Board APPLICATION FOR CERTIFICATION AS QUALIFYING FARMLAND AND DESIGNATION AS AN ORANGE COUNTY VOLUNTARY AGRICULTURAL DISTRICT / ENHANCED VOLUNTARY AGRICULTURAL DISTRICT INSTRUCTIONS: Before completing the application, please review the provisions of the Orange County Voluntary Farmland Preservation Program Ordinance, and fill out the form as accurately and completely as possible. Please sign and date the form, and return it to the Department of Environment, Agriculture, Parks and Recreation PO Boar 6181 - 306 Revere Road, Hillsborough, NC 27278 APPLICANT: Address: 1 9 H 0- City: State: IV Q Zip Code: v Phone Number (Day)7`/ 3 _- -'7 4 � (Evening) E -Mail: PROPERTY INFORMATION: Property Location /Address: Township: Tax Map`} � Block:_ Lot: e Township Tax Map Block:_ Lot:$ Township Tax Map: Block:_ Lot: Township:_ Tax Map:_ Block:_ Lot:_ Parcel Identification Number (PRgFAo / q ` � - TsParcel Identification Number (PIN):'`? 3 0, ;� - 4 Parcel Identification Number (PIN) 334c Wee,, *Parcel Identification Number (PIN): n, /7S Number of Acres: 5 Deed Book: Page: i `?S" €3 r ! 52-?. Does this land have a plan on file with the Natural Resources Conservation Service or NC Forest Serv' e? Yes: No: If "No ", please complete back of form Is this land listed for Present Use taxation with the Orange County Tax Office? Yes: 4'- , No: If "No ", please complete back of form I [WE] ARE SEEKING DESIGNATION AS A VOLUNTARY AGRICULTURAL DISTRICT I [WE] ARE SEEKING DESIGNATION AS AN ENHANCED VOLUNTARY AGRICULTURAL DISTRICT OWNER[S] CERTIFICATION: [We], the applicant[s], hereby certify that, to the best of my [our] knowledge, the foregoing application is complete and accurate. Signature: pK /~ z�� Date:= Signature: t'3 Date:�� `f-